Applying for a Kaiser Permanente for Individuals and Families plan is a simple process, but it helps to be prepared. Please review the checklist below. Then, if you would like to apply online click the continue button. If you would like to apply on a paper application, download the file provided below.

Note: If you choose to complete an online application, you can save your application at any point in the process and return later to complete it.

If you are a current member with Individual and Family Plans and would like to look at other product options, please contact Member Services at 1-866-298-1499. Please do not use this site to request plan changes.

Due to site upgrades, only the paper application is available at this time. Please return this fall, when we'll launch new and enhanced apply online features.

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Kaiser Permanente of Hawaii has established an open enrollment period during the month of November 2011 for applicants under the age of 19 who are seeking their own individual health coverage plan or a child-only plan.

A child under the age of 19 may apply to enroll in our KP 20/Rx or KP 30/Rx plans only during this open enrollment period unless he or she experiences certain qualifying events and submits an application and supporting documentation within 31 days of the qualifying event. For more information on qualifying events and how to apply, call 1-800-494-5314.

A child who has not experienced a qualifying event can still get coverage outside the open enrollment period by enrolling in our KP Basic Plan.

Getting Coverage for Children

If you plan to apply for coverage for a child under age 19, you must do so during our open enrollment periods, March 15 through April 30 and September 15 through October 31. If your child has experienced a qualifying event (divorce; loss of employer-sponsored coverage; loss of Medicaid or other public program's benefits; moving from his or her health plan's service area; birth; or adoption), you may submit an application outside the open enrollment periods within 31 days of the qualifying event. In addition, we will accept applications received within 60 days of the birth or adoption of a child. Simply call 1-800-280-7329.

You will need to submit a paper application with the appropriate support documentation. Please refer to the "Getting Coverage for Children" brochure and "Application" located on the left side of the page for instructions on how to apply.

For additional coverage options for children available through the Washington State Health Insurance Pool (WSHIP) or the federal Pre-existing Condition Insurance Plan (PCIP-WA), contact WSHIP at 1-800-877-5187 or PCIP-WA at 1-877-505-0514.

If you would like to apply for coverage with a July 2013 effective date, please return to our website on or after May 16, 2013. Otherwise, please select an earlier effective date and continue with the application.

If you would like coverage effective June 15, 2013, we must receive your application on or before 9 p.m., June 8, 2013. Otherwise, you will need to reapply for coverage effective July 1, 2013.

If you are applying for coverage with a 2012 effective date, please continue with the application process.

If you would like to apply for coverage with a 2013 effective date, please return to our website after October 30, 2012, when our 2013 plans and rates will be available.

If you are applying for coverage with a 2012 effective date, please continue with the application process.

If you would like to apply for coverage with a 2013 effective date, please return to our website on or after November 1, 2012, when our 2013 plans and rates will be available.

If you are applying for coverage with a 2012 effective date, please continue with the application process.

If you would like to apply for coverage with a 2013 effective date, please return to our website on or after December 8, 2012, when our 2013 plans and rates will be available.

If you are applying for coverage with a 2012 effective date, please continue with the application process.

If you would like to apply for coverage with a 2013 effective date, please return to our website on or after October 31, 2012, when our 2013 plans and rates will be available.

The benefits and monthly rates listed are valid through December 31, 2012. If you would like to apply for these plans with a 2012 effective date, we must receive your application by December 8, 2012. Beginning January 1, 2013, the plans, benefits, and monthly rates for Kaiser Permanente for Individuals and Families plans will change.

If you would like to apply for coverage with a 2013 effective date, please return to our website on or after December 8, 2012, when our 2013 plans and rates will be available.

If you are applying for coverage with a 2012 effective date, please continue with the application process.

If you would like to apply for coverage with a 2013 effective date, check back soon. We expect our updated rates and plans to be available shortly.

If you are applying for coverage with a 2012 effective date, please continue with the application process to lock in your 2012 rate.

If you would like to apply for coverage with a 2013 effective date, please come back on or after December 20, 2012, when our 2013 plans and rates should be available.

Please DO NOT USE your browser's "BACK" or "FORWARD" buttons within this application.To navigate this site, please use the navigation links or buttons provided on our site.

Thank you for choosing to apply for a Kaiser Permanente Individual and Families plan.

We can help you find affordable health care coverage that starts in 2014. To start shopping for a great plan, visit Buykp.org.

For assistance, please call us at 1-800-494-5314 or contact your agent or broker.

Application Checklist

Please enter the ZIP code for your primary residence

*ZIP Code:

State:

County:

*Requested Effective Date:

We will notify you of your effective date in your acceptance letter, if we approve your application. We will do our best to honor your desired effective date. If for some reason there is a delay in processing your application, we will select the next available effective date.

Each family member applying for coverage will need to fill out a separate application.

*If you are 65+ years of age and Medicare eligible, or are under age 65 and entitled to Medicare on the basis of Social Security disability, call 1-866-949-5142 for information about our Kaiser Permanente Medicare Plus plans.

Note: Application must be accompanied by payment information for your initial premium. Please make certain that you have provided all information requested. Premiums for enrollments beginning on the 15th of the month will be prorated for that month only, after which the standard billing cycle (1st of the month) will apply.

Note: All applications must be accompanied by a credit/debit card payment for the first month's premium. Please make certain that you have provided the necessary information requested. Premiums for enrollments beginning on the 15th of the month will be prorated for that month only, after which the standard billing cycle (1st of the month) will apply.

We will do our best to honor your desire effective date if you are approved. If for some reason there is a delay in processing your application, we may need to select the next available effective date.

Note: Effective dates for applicants under the age of 19 may vary.

Welcome to our new Kaiser Permanente for individuals and families online website, designed for coverage starting February 1, 2010 and beyond.

Please note: Because you selected an effective date of January 1, 2010, or January 16, 2010, you'll need to use our previous site to help you find the plan that's right for you, get a quote, and apply online. Please click here to apply for January 2010 effective dates. We apologize for any inconvenience.

If you have any questions, please contact your agent, broker or call us at 1-301-816-6767 to get started today!

Welcome to our new Kaiser Permanente for Individuals and Families online Web site. Please note: The site is under construction for our Georgia region. Because you selected a Georgia ZIP code, you'll need to click here to find the plan that's right for you, get a quote, and apply online. If you have trouble with the link, simply copy this url into your browser: https://kaiserga.inshealth.com If you have any questions, please contact your agent or call us at 1-800-538-5064 to get started today! We apologize for any inconvenience.

The earliest your coverage will begin is the first or 15th of the month following receipt of a completed application and first month's premium. Coverage will not be back dated.

*Are ALL applicants current Kaiser Permanente members?

Yes

No

The 2011 Kaiser Permanente for Individuals and Families rates, benefits, and membership application form are still pending state regulatory review and may be subject to change. However, your application will be processed, and we will notify you of its status.

How will the application be completed?

Select the method in which the application will be completed.

You may choose to complete the application online or on paper. If you choose to complete the application electronically (online), you also agree to receive a response from Kaiser Permanente electronically. You will have an opportunity to print a copy of your completed application and Kaiser Permanente's responses for your records.

Your online medical questionnaire and the assessment of eligibility that will be issued by Kaiser Permanente, possibly including medical information, can be viewed by any member of your household who has the user ID and password for this Web application.

If you do not wish to provide your email address, please follow instructions to download and mail a paper application.

If you think you might like to download the paper application, please do so now. Once you have started the online application, you will not be able to return to this page to download it.

Please choose which version of the paper application you would like to download:

EnglishSelect the ''Paper Application'' radio button, then click the ''Continue'' button.

Depending on the type of plan you're applying for, you may need to have the following information on hand.

Medical History information for applicants, including medications and treating physician information

Medical History information for Applicants, including medications and treating physician information

2. Sign the Application

You'll need to sign the application with an e-signature letting us know that you understand the agreements and authorizations of the application. The signature of each Applicant who is an adult will be required to personally submit an electronic signature on his or her own behalf to sign the application.

You'll need to sign the application with an e-signature letting us know that you understand the agreements and authorizations of the application. The signature of each Applicant who is an adult will be required to personally submit an electronic signature on his or her own behalf to sign the application.